Thursday, January 15, 2009

3 Second Pauses's cold here in Florida....we're talking in the 30's...brrrr. I want my 70 something degree weather back!

Work was ok this week. We are trying something new at our hospital = admission nurse. I am loving this idea because it helps us floor nurses tremendously. I will be sad when they take this idea away, because they always take the good ideas away. For now though, I will enjoy it!

Last night was my somewhat stressful night. I am getting back into the swing of things and while it has been hectic at shift change and for about 4 to 5 hours after shift change, I find that I am not feeling overwhelmed anymore. You just do what needs to be done & try not to stress about it because it really won't do anyone good if you're stressed out. That's my attitude anyways.

Last night I had a good reason to be stressed though. One of my patients had a heart rate that would climb up & sustain at 145 to 150, then suddenly drop to 35....and repeat over & over. So I call the cardiologist who happens to be the chief of staff too. Amazingly, he calls me back within 5 minutes (record time for him). He gives me an order for Lopressor & that's it. Doesn't ask if she's symptomatic or even what her blood pressure is....just "give her Lopressor...". So I give the Lopressor and about 30 min later she starts having 2 to 3 second pauses about every 30 to 90 seconds. Eeeekkkk! Basically her heart is ceasing to beat for 2 to 3 seconds, every minute. We were all watching the heart monitor, just amazed by what we were seeing.

I called my clinical leader to come assess the situation. The patient's blood pressure was good, she was asymptomatic...but still...her heart was stopping & restarting just about every minute. So I call the cardiologist again....wait 15 min, page him again, wait 15 min, page him again......this is his norm = no call back. Ridiculous...did I mention he's also chief of staff at this hospital? Ridiculous! The patient is continuing with her every minute pause, heart rate dropping to 30 & then climbing up to 145 & repeat the pause cycle. After my 3rd attempt to reach the doctor, I make my co-workers swear to me that if I ever end up in this hospital & I am in a coma or unable to make any medical decisions & this doctor happens to be consulted.....pleaseeeeeee make them get someone else. They promised they would take care of that.

I inform my clinical leader that the doc isn't returning any of my pages so we involve the nursing supervisor who promptly gets him on the phone. I explain to him what's been going on...3 second pauses every minute for the last hour....I was fully expecting he'd be sending her to ICU. His reply "Just continue to watch." What????????? Sit here & watch her pause all night? "Yes, nothing else." Ughhhhhhhhh...I repeat the promise my co-workers have made to make sure this doctor is NEVER my doctor & I wrote out what he said as an order..."Continue to monitor pt's HR/pauses." I wasn't going to be the one looking like a moron if this patient coded. I did what I could do. I was a little stressed because I knew this was not a good situation & at the very least, we should probably have an external pacemaker at bedside...but we didn't.

By some miracle (or maybe my repeated prayers), about 15 min after I talked to the doc, her heart stopped pausing & she was back into her normal rhythm & pretty much remained there the rest of the night. I was shocked....yet very relieved.

I'm exhausted today...I got about 2 hours of sleep because I had to pick up my brother's kids from school. I'm ready to take a shower & go to bed now (it's not even 7 pm yet...ahhh). I have an early lunch tomorrow with my mom, sister-in-law & aunt. It should be a good time.

Update on the Twilight saga (mostly for Amanda's I am currently on the 3rd book & still have yet to become obsessed with this series. Is there something wrong with me? Everyone else I know has read all 4 books in about a week or less...some are even rereading it (that I cannot imagine myself ever doing). I did see the movie twice & I will admit...I couldn't really stand Edward at first, but he is growing on me....although at the moment I think he's a freakish, obsessed, controlling I like Alice's character though. And Bella too. I think the actor that played James is hottttttt even though my niece calls me a trader for liking James. :)

Come or not??? He didn't exactly look like this in the movie, but still....very hot!
Ok, time to shower, watch AI, maybeee read a little more & then catch up on some sleep. Take care!


Amanda said...

Hmmmm. I was hooked on the first book and then was less into it in the 2nd 3rd and 4th. By the 4th, I was thinking, "now this is getting a little out there." But a family of vampires is completely normal right?
I can not believe that doctor. The benefit of a ateaching hospitla is that there are almways tons of docs on staff, even at 3 am. The downside> Interns that do not know ANYTHING!

Pamela said...

That heart rhythm would have scared me to death! I would have been nervous the whole shift! Can't believe they didn't put the pt in ICU??? WTH??
Glad you got an admission RN. That will be a HUGE help. They need to do SOMETHING to make it better.
Have a good night.